Reverse Posterior Interosseous Artery Flap for Reconstruction of the Wrist and Hand after Sarcoma Resection

Objective: To report our experience of posterior interosseous artery flap reconstruction of the wrist and hand after soft tissue sarcoma resection. Methods: Thirteen patients who presented to our institution for treatment of soft tissue sarcomas of the wrist and hand from February 2007 to January 2009 were prospectively enrolled. After tumor resection, the soft tissue defects were covered with posterior interosseous artery flaps. Relevant patient characteristics, results of creation of flap and functional outcomes were reviewed. Relevant clinical characteristics were recorded prior to surgery. The size, pedicle length and thickness of flaps were measured intraoperatively and complications evaluated two weeks after surgery. Functional outcomes and aesthetic results were evaluated 6 to 24 months after surgery, using Enneking's Musculoskeletal Tumor Society (MSTS) 93 functional scoring system. Results: The patients' ages ranged from 14 to 82 years (54.92 +/- 19.09 years), including six aged >65 years. Flap sizes varied from 5 cm x 3 cm to 8 cm x 5 cm. Flap survival rate was 100%. One patient had partial necrosis of the Z-shaped incision, which healed with routine wound care. Mean Musculoskeletal Tumor Society functional score was 27.31 +/- 3.68. Eleven patients were alive and disease-free at a mean follow-up of 36 months. One patient died of pulmonary metastases 18 months after surgery. One patient developed recurrence and underwent amputation 12 months after surgery. Discussion: Reverse posterior interosseous flaps are reliable flaps for reconstruction of the wrist and hand after soft tissue sarcoma resection. They are suitable for elderly patients. The one-stage surgery and primary healing allow for timely postoperative adjuvant therapy following this type of reconstruction.